Sociodemographic and Clinical Correlates of Multidrug-Resistant Uropathogens in Hospitalized Children

Khitam Muhsen,1 Sama Haleem,1 Bshara Mansour,2,3 Ma’anit Shapira,4,5 Milena Pitashny,4,5 Mohammad Masarwa,6 Muna Omar,1 Wasef Na’aminh,1,* Eias Kassem5,6,* 1Department of Epidemiology and Preventive Medicine, School of Public Health, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; 2Pediatric Department and Pediatric Nephrology Service, Saint Vincent de Paul Hospital, Nazareth, Israel; 3The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; 4Clinical Laboratory Division, Hillel Yaffe Medical Center, Hadera, Israel; 5Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; 6Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel*These authors contributed equally to this workCorrespondence: Khitam Muhsen, Department of Epidemiology and Preventive Medicine, School of Public Health, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel, Tel +972-3-6405945, Fax +972-3-6409868, Email [email protected]: Antibiotic resistance in uropathogens causing urinary tract infections (UTIs) is increasing; nonetheless, evidence on multidrug-resistant (MDR) bacteria remains limited. We aimed to examine the prevalence and risk factors of Gram-negative MDR bacteria in pediatric UTIs and compared the hospitalization duration and cost between patients with and without MDR.Patients and Methods: A retrospective single-center study was conducted among hospitalized children from 2015 to 2020. Sociodemographic (age, sex, population group, residential socioeconomic status), clinical (prior hospitalizations, antibiotic use, background diseases), and laboratory (complete blood count, C-reactive protein levels) data were collected from medical files. MDR was defined as non-susceptibility to ≥ 1 agent in ≥ 3 antimicrobial classes.Results: The study included 506 children (81.8% girls; median age 11 months). Most (94.2%) isolates were Gram-negative. Resistance to ampicillin, trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, nitrofurantoin, cefuroxime-axetil, and cefuroxime-sodium was 33.8%, 12.4%, 9.4%, 3.9%, 3.2%, and 2.5%, respectively. MDR prevalence was 6.9% (95% CI 4.8– 9.5), and 50.8% (46.4– 55.4) showed resistance/intermediate susceptibility to 1– 2 antibiotic categories. Arab children had an increased likelihood of MDR (OR=3.29 (95% CI 1.49– 7.25) than Jewish children, and children with vs. without a history of antibiotic use before hospitalization (5.06, 1.67– 15.31). The likelihood of resistance/intermediate susceptibility to 1– 2 antibiotic categories increased in relation to antibiotic use before hospitalization (2.68, 1.25– 5.74) and in males vs. females (1.71, 0.99– 2.94). No significant differences were found in hospitalization duration or cost between the MDR groups.Conclusion: The prevalence of MDR and non-susceptibility/resistance to 1– 2 antibacterial categories in Gram-negative uropathogens is concerning. Our findings underscore the need for tailored empirical therapy and targeted antibiotic stewardship interventions.Keywords: urinary tract infection, children, uropathogens, antibiotic resistance, multidrug resistance